To President Donald J. Trump: A Blueprint for Solving Our Nation’s Addiction and Overdose Problems

We are a diverse group of addiction treatment, education and research professionals with a commitment to reforming our drug treatment system, which we believe is a system in need. It is our goal to create a system that is accessible and effective for all who need treatment. To this end, we are providing an outline of our blueprint for accomplishing this. It is our hope to work with you and your administration to create a more responsive and successful treatment system – one that will engage and help many more individuals with drug and alcohol problems.

The Scope of the Problem

Our government estimates there are over 22,000,000 people who need help with their alcohol or drug use. Only 10% of these troubled individuals ever receive the treatment they need and, for many, treatment is a revolving door of failure. With unabated opiate and overdose problems, we believe that substance use is a public health and human rights issue and embracing and integrating our recommendations will save the lives of many more Americans in need by engaging them in effective treatment.

Limitations of Our Current Abstinence-Only Treatment System

A central problem in the current system is that it places an emphasis on abstinence as the only way to address problematic drug and alcohol use. In some cases, a commitment to pursue abstinence is often a requirement to enter and remain in treatment. While this paradigm of care has been created with the best of intentions, it is, unfortunately, failing to meet the needs of great numbers of people who are wrestling with problematic substance use and addictions. Furthermore, it is an approach that is not in tune with evidence-based clinical practices and contemporary research findings.

Toward an Effective Addiction Treatment Policy

Problematic and addictive alcohol and drug use is a Biopsychosocial disorder. As such, both our conceptualization of the problem and our approaches to treating it will be more effective if we remain anchored in these dimensions.

Biological/Medical. The primary contribution in the Medical dimension has been the creation of an array of life saving medicines that can help people reduce or end their use of substances. These include: (1) opiate agonist therapies such as Methadone and Buprenorphine; (2) opiate antagonist therapies such as Naltrexone; and (3) alcohol-focused medications such as Disufiram (Antabuse), Topiramate, and Acamprosate. Medication Assisted Treatment (MAT) reform with Methadone and Buprenorphine needs to be our number one priority. MAT, as well as all evidence supported treatments, must be available to all who need and want them regardless of their ability to pay. MAT should be available without counseling requirements that can be barriers to accessing these medications, though there is some research suggesting that psychosocial interventions improve MAT’s effectiveness so many psychosocial therapies should be available as options.

Given the current problem of prescription opiate overdose deaths, the availability of these medications – as well as naloxone which can reverse an overdose – is vital. Restricting availability of these prescriptions, as a means of fighting addiction, can be completely counterproductive.

Psychological. Problematic substance use is complex. There are frequently arrays of emotional problems that not only preceded the addiction, but also stem from it or are co-occurring. Inner pain and suffering play a well-known role in the onset and maintenance of addiction and there are additional psychological consequences as the alcohol and drug use takes on a life of its own as the individual approaches or crosses the line to addiction. This means that the Psychological approaches must work on two fronts. They must serve to empower people to not only understand how their addiction works, but have strategies and tools to regain control of their lives and re-claim their freedom. Thankfully, we have available to us an array of evidence-based interventions including Relapse Prevention, Cognitive-Behavioral Therapy, the Community Reinforcement Approach, Mindfulness-Based Interventions, Motivational Interviewing, Contingency Management, Trauma-focused therapy and Psychodynamic Psychotherapy that can each play an important role in a comprehensive approach to addiction treatment. We also believe that effective Prevention efforts must be emphasized, particularly for children living in dysfunctional or vulnerable families and social environments. There must be corresponding help for families, including children, impacted by Substance Use Disorders.

One reason why the abstinence-only approaches have low levels of efficacy is because they did not address the trauma and self-hatred, which often underlie and drive the drug and alcohol use. Here there is a profound need for the in depth psychotherapies and the use of cognitive, behavioral, experiential, and existential therapeutic techniques and interventions.

Social. The Social dimension focuses on the pathogenic impact of being a member of a stigmatized group and/or living in poverty or other difficult social-economic circumstances. The resultant breakdown of families in these environments further contributes risk factors for problematic substance use. In these situations, interventions that increase a sense of community, empower families, strengthen relationships with existing and emerging institutions, transform schools into 18-hour-a-day social centers, and provide housing for the homeless and jobs and other vehicles for identity formation will all play a role in reducing both the amount of drugs and alcohol being used and the negative impact of both addictions and crime in our communities.

Harm Reduction. Alcohol and drugs can have an extremely destructive impact on the lives of those who use them; they also help them function as they can reduce suffering and bring some meaning to people’s lives – at least in the short-term. This means that most people are very ambivalent about bringing their substance use to an end. In addition, the use of substances can lead to serious injury, illness, and/or death in both the short- and long-term. However, at the point that people who use drugs become concerned about their use, the majority is not ready, willing or able to stop using. This is where treatment must engage people. The harm reduction framework is appealing and relevant to this large group of people because it “meets people where they are” as unique people in unique social circumstances and accepts them into treatment partnering collaboratively around their motivation and positive change goals. Harm Reduction is an umbrella term for a set of principles and a wide range of interventions that: (1) reduce the immediate risk of death (e.g., opiate-related overdose); (2) help make it less likely that they will contract serious medical diseases (e.g., AIDS, hepatitis C, endocarditis, etc.), and (3) serve to provide services and form relationships that will help those with drug and alcohol problems gradually move toward a state of abstinence or non-addictive use. Life saving harm reduction interventions include: 1) wide distribution of the opiate blocker, Naloxone, to reverse potentially lethal overdose; 2) sterile syringe availability to prevent infection and 3) harm reduction psychotherapy and counseling to bridge from public health interventions to the full array of evidence-based addiction treatment interventions described earlier. We feel that the implementation of these tools is not only the moral, but also most cost effective, way to help people who struggle with drug problems to thrive in our society.

Moving Forward

Because of the tragic seriousness and the profound complexity of the issue, all four forms of intervention and treatment are central to the creation of an effective and humanistic American drug treatment policy.

We are at the beginning of a new era in addiction treatment and there is much work to be done. We hope to begin a dialogue with your administration so that we can find a way to implement these principles and practices in our nation’s fight against the ravages of drug and alcohol addiction.

Sincerely,

Mackenzie Amara, MA

Bill Barclay
Retired Addiction Psychiatrist.
Former Medical Director of Addiction Medicine at Ohio
Former Director of Addiction Treatment Services for the Department of Psychiatry at University of Louisville.

Linda Berkeley
CBT Therapist and Substance Misuse Therapist

Michler Bishop, PhD.
Director of Alcohol and Substance Abuse Services
The Albert Ellis Institute

Rebecca Block, PhD,
Clinical Psychologist
Past-President
Division on Addiction, New York State Psychological Association

Molly Bobek, LCSW
Family Therapist at Center for Optimal Living
Teaching Faculty, Ackerman Institute for the Family

Ilana Breslau PhD
Asst Professor of Psychiatry, Albert Einstein College of Medicine
Director of Continuing Education, North Central Bronx Hospital

Tyrone Thaddaeus Brown, PhD, MSOL, CADT
Independent Health and Human Services Consultant
Brooklyn, NY

Tim Cheney
Co-Director
Chooper’s Guide, Choopers Foundation
Grace Street Recovery Services

Amy J. Colley, Ph.D.
Addiction Psychologist

John Crepsac, LCSW, ICADC
Adjunct Faculty Adelphi University & NYU

Mari Dickerson, LMSW
Psychotherapist at the Center for Optimal Living

Ernest Drucker PhD
Research Scientist and Professor of Public Health
New York University , College of Global Public Health

Thomas Dybek, CASAC

Anne Earle, LMSW, CARC
Addiction Recovery Coach

Eddie Einbinder, LMSW
Harm Reduction Psychotherapist at The Center for Optimal Living
Documentarian, Author and Lecturer in Drug Education

Jeff Foote, PhD & Carrie Wilkens, PhD
Co-Founders
Center for Motivation and Change

Jocelyn Fraum, Psy.D.
Private Practice and Center For Motivation and Change, NYC

Marc Galanter, M.D.
Professor of Psychiatry at NYU

Colleen Maloney Garlock, CDCA
MAT Program Case Manager for Signature Health
Willoughby, OH USA

Ruth E Gasparik, LCSW, CASAC.

Kevin Gillespie, Executive Director
Integrated Services for Behavioral Health
Athens, Ohio

Judith Gordon, Psychologist in Private Practice
Co-Editor, Relapse Prevention

Douglas Greene
New York CASAC-T

Gayna Havens, PhD
Clinical Psychologist
Division on Addictions, New York State Psychological Association

Reid Hester, Ph.D.
Director, Research Div., & Senior Science Advisor
Checkup & Choices, LLC

Julie Holland, M.D.
Psychiatrist and Author

Adrian S. Hooper, Jr.
Co-Director
Chooper’s Guide, Choopers Foundation
Grace Street Recovery Services

Tom Horvath, Ph.D.
President, Practical Recovery

Marjorie Israel
M.A. Psychology, The New School

Adi Jaffe, Ph.D.
Co-Founder & Executive Director
Alternatives Behavioral Health, LLC.

Howard Josepher, CSW
Founder and Executive Director of Exponents, Inc.

Richard Juman, Ph.D.
Past President
Division on Addictions, New York State Psychological Association

Carol Katz – Beyer
Co-founder, Families for Sensible Drug Policy

Scott Kellogg, PhD
Past-President
Division on Addictions, New York State Psychological Association

Mary E. Kelly, Psy.D.
Clinical Psychologist
Private Practice, NYC

Marc F. Kern Ph.D.
Alternatives Behavioral Health, LLC.
Chairman of the Board of Moderation Management

Edward J. Khantzian, MD
Professor of Psychiatry, Part Time
Harvard Medical School

Nicholas Lessa, LCSW, MA, CASAC
President and CEO
Inter-Care, Ltd.

Barry Lessin, M.Ed., CAADC
Licensed Psychologist
Co-founder, Families for Sensible Drug Policy

Marc Lewis, Ph.D.
Professor Emeritus, University of Toronto

Lisa Caren Litt, Ph.D.
Visiting Scholar, Teachers College, Columbia University
President-Elect
Division on Addictions, New York State Psychological Association

Gabor Maté M.D.
Adjunct Professor, Faculty of Criminology, Simon Fraser University
Author, In The Realm of Hungry Ghosts: Close Encounters With Addiction

Diane W McAdams ACSW, LCSW, CAP. Private Practice. Stuart, FL

David McNamara
CASAC-T at Cornerstone of Rhinebeck.

Robert J. Meyers, Ph.D. Associate Emeritus Professor of Psychology
University of New Mexico, & Director of Robert J. Meyers Ph.D., & Associates

Onaje Muid
MSW, CASAC, LMHC
Adjunct Lecturer
Columbia University, School of Social Work
Fellow, New York Academy of Medicine

Lisa Najavits, PhD
Director, Treatment Innovations
Professor, Boston University School of Medicine

Charles Novak, MLADC
Clinical Director
New Paths Counseling and Recovery Services
New Hampshire

David G Ostrow, MD, PhD, LFAPA
Vice President for Membership Services and Community Based Research
The American Academy of Cannabinoid Medicine (www.info@AACM.org)

George Parks, Ph.D.
Founder and President
Compassionate Pragmatism, Inc.

Edward Paul, MD
Clinical Associate Professor
NYU Dept. of Substance Abuse Services

Will Pitts, LMSW

James Powers, DACM, L.Ac.
Doctor of Acupuncture and Chinese Medicine

Devora Reichman, PsyD
Clinical Psychologist at the Center for Optimal Living

Katherine Riva MD
Resident Psychiatrist
University of Pennsylvania

Frederick Rotgers, PsyD, ABPP
Psychologist in Independent Practice
Adjunct Professor of Psychology
John Jay College of Criminal Justice

Debra Rothschild, PhD
Clinical Psychologist, NYC
Past President, NYS Psychological Association Division on Addictions

Carolyn Schaefer, LCSWR
Clinical Social Worker

Liz Schnee, MPH
Community Health Educator

Samuel L. Sharmat, MD
Founder and President
Sharmat Psychiatric Group

Linda Carter Sobell, Ph.D., ABPP
Professor
Board Certified in Behavioral and Cognitive Psychology
Licensed Psychologist, Florida

Mark B. Sobell, Ph.D., ABPP
Professor
Board Certified in Behavioral and Cognitive Psychology
Licensed Psychologist, Florida

S. Lala A. Straussner, PhD
Professor and Director, Post-Master’s Certificate Program in the
Clinical Approaches to Addictions

Neta Tal, PhD
Clinical Psychologist at Center for Motivation and Change
Private Practice

Jenifer Talley, PhD
Assistant Director, Concentration in Mental Health and Substance Abuse Counseling, The New School for Social Research
Assistant Director, The Center for Optimal Living

Andrew Tatarsky, Ph.D.
Past-President
Addiction Psychologist
Division on Addictions, New York State Psychological Association
Founder and Director, The Center for Optimal Living.

Arnold M. Washton, Ph.D.
Addiction Psychologist
New York, NY and Princeton NJ

Andrew Weintruab, PhD
Member, Executive Committee
Division on Addictions, New York State Psychological Association

John Welch, LCSW

Charles Wininger, LP, LMHC

Jami Wolf-Dolan, PsyD
President
Division on Addictions, New York State Psychological Association
Private Practice and Center For Motivation and Change, NYC

Katherine van Wormer
Professor of Social Work at University of Northern Iowa
Co-author of Addiction Treatment: A Strengths Perspective


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